Facial neuropathy.

Diseases of the peripheral nervous system. Mononeuropathy of the upper and lower extremities. Plexopathy.

Topic questions.

1. Features of terminology.

2. Classification of the peripheral nervous system diseases.

3. Facial neuropathy.

4. Trigeminal neuralgia.

5. Herpetic and postherpetic trigeminal ganglioneuropathy.

6. Plexopathy:

1) brachial plexopathy:

- upper brachial Erb-Duchenne plexopathy

- lower brachial Dejerine-Klumpke plexopathy

2) Lumbo-sacral plexopathy

7. Mononeuropathies of the upper extremities.

1) radial nerve

2) ulnar nerve

3) median nerve

8. Mononeuropathies of the lower extremities.

1) femoral

2) peroneal nerve

3) tibial nerve

9. Compression-ischemic mononeuropathy (tunnel syndrome).

10. General principles of treatment of the peripheral nervous system pathology.

Features of terminology.

Depending on the localization of lesions among the diseases of the peripheral nervous system distinguish neuropathy (neuritis) - lesion of one nerve, neuralgia - nerve damage, the main manifestation of that is pain, polyneuropathy (polyneuritis) - multiple nerve damage, radiculopathy (radiculitis) - lesions of spinal roots, plexopathy (plexitis) - lesion of the nerve plexus and ganglioneuropathy (ganglioneuritis) - ganglion lesion. The terms with end - it («neuritis», «radiculitis», «plexitis») literally means inflammation (bacterial or viral) of the particular structure of the peripheral nervous system.

However, there are non-inflammatory (ischemic, toxic and metabolic) nerve injury. In this case degeneration of the peripheral nerve fibers with motor, sensor and vegetativ disorders is called not neuritis but neuropathy.

Classification of the peripheral nervous system diseases (based on the anatomical principle).

1. Vertebrogenic injury of the peripheral nervous system.

2. Injury of spinal roots (radiculopathy), ganglions (ganglipathy), plexuses (plexopathy).

3. Multiple injury of peripheral nerve, roots (infection-allergic acute Guillian-Barre polyneuropathy, polyneuropathy due to diphtheria, botulism, allergic, paraneoplastic, congenital, metabolic (diabetic or alcohol) polyneuropathy).

4. Injury of peripheral nerve (traumatic, compression-ischemic and inflammatory genesis).

5. Injury of cranial nerves (neuralgia, neuropathy).

Facial neuropathy.

Causes of the facial nerve swelling and inflammation:

- blood disorder as a result of local hypothermia (blowing by cold air)

- virus - HSV- 1 activation,

- infection (mumps, Lyme disease, poliomyelitis),

- Melkersson-Rosenthal syndrome (a rare hereditary disease with recurrent orofacial swelling, relapsing facial paralysis and fissured tongue)

- inflammation of the ear,

- face and skull traumatic injuries,

- stroke, diabetes or atherosclerosis with blood circulation disorders, demyelination at multiple sclerosis

Typically, neuropathy of the facial nerve is unilateral, bilateral Bell’s palsy occurs only in 2 % of cases. In some cases relapsing of the facial neuropathy may occurs.

There are two types of facial neuropathy:

- primary neuropathy (Bell’s palsy) – the most often idiopathic tunnel facial nerve damage. It occurs in the canal of the temporal bone before exiting through the stylomastoid foramen where it leaves the skull (Fig. 1). Narrow bone canal often provokes the compression of the nerve during to development of edema due to endogenic or exogenic causes (at colds, disorder of cerebral blood circulation,).

- secondary neuropathy -consequence of infection, inflammation, toxicity, and other similar causes.

Main symptoms of Bell’s palsy:

1) prosoparesis (Fig. 1) – mimic muscles paresis of (usually) one half of the face with facial asymmetry at rest that increases with mimic movement:

- disappearance of the nasolabial folder, patient can’t arise the corner of mouth for smile, whistle or blow out cheek

- chewing food on the affected side may be a problem, food may get trapped between gum and cheek. Drinks and saliva may escape from the side of mouth,

- patient can’t close an eye (lagoftalm), arise eyebrow, wrinkle forehead,

- Bell’s phenomenon – visible motion of eye up at attempt to close an eye,

- eyewatering (due to weakness of m. orbicularis oсuli (paretic lower eyelid) tear misses the nasolacrimalduct and flow out from eye).

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